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ARTICLE
Year : 1969  |  Volume : 17  |  Issue : 1  |  Page : 27-30

Exanthemata : A causative factor of chronic dacryocystitis in children


Department of Ophthalmology, Medical College, Jabalpur, India

Date of Web Publication4-Jan-2008

Correspondence Address:
P K Mukherjee
Department of Ophthalmology, Medical College, Jabalpur
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Mukherjee P K, Jain P C, Mishra R K. Exanthemata : A causative factor of chronic dacryocystitis in children. Indian J Ophthalmol 1969;17:27-30

How to cite this URL:
Mukherjee P K, Jain P C, Mishra R K. Exanthemata : A causative factor of chronic dacryocystitis in children. Indian J Ophthalmol [serial online] 1969 [cited 2020 Aug 9];17:27-30. Available from: http://www.ijo.in/text.asp?1969/17/1/27/37577

Table 2

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Table 2

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Table 1

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Table 1

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It is a common experience to see faces of the majority of children, presenting as chronic dacryocystitis, bearing scars of small pox or chicken pox. On questioning, it is invariably revealed that the symptoms of epiphora develop after recovery from either of the conditions. MISHRA pointed out the importance of small pox as an etiological factor of dacryocystitis. This observation led us to undertake the study to find out the extent to which exanthematous diseases contribute to chronic inflammation of lacrimal sac in childhood and adolescence.


  Material And Method Top


The study was carried out on 100 consecutive cases of chronic dacryocystitis who presented at the ophthalmic out-patient department of the Medical College Jabalpur. They included cases of congenital dacryosystitis as well.

The diagnosis was made on the following factors -

i. Epiphora due to block in the nasolacrimal duct. Cases of epiphora due to changes in lids, puncta and canaliculi were not included.

ii. Swelling over the region of the sac.

iii. Regurgitation of pus or mucoid discharge from either of the puncta on pressure over the sac.

iv. Fluorescein patency test.

v. Syringing of the nasolacrimal passage.

In small children epiphora, swelling over the sac and regurgitation on pressure were considered to be diagnostic.

In all patients history of small pox, chicken pox and measles was asked. Incidence of small pox was obvious by pock-marks on face, and evidence of chicken pox was confirmed by history and faint scars on the face and thorax. The interval between recovery from small pox or chicken pox and epiphora was also noted. Nasal examination in all such cases was done.


  Observations Top


Leaving aside the congenital cases, the age group A is left with 28 cases of acquired dacryocystitis, all of chronic nature. This is larger than any other single age group, as can be seen in the table.

There is a general preponderance in females of acquired chronic dacryocystitis, the overall ratio being females to males as 2:1. Only in the last group over 61 years, males were affected more than females, but the total number is too small to draw a significant conclusion.

[Table - 2] shows the probable etiological factor in 28 acquired cases of the youngest age group A with the relative sex incidence.

Thus it is observed that 82 per cent of acquired cases of group A had suffered from small pox or chicken pox, viz. 50 per cent from chicken pox, 32 per cent from small pox and in 18 per cent no obvious cause could be determined. Interval between the recovery from small pox or chicken pox and onset of epiphora was less than 6 months in all cases, varying from 1 to 6 months. Nasal examination in all cases showed no abnormality or pathology in the nose. There were no cases of measles in the series,


  Discussion Top


Contrary to the widely accepted view that chronic dacryocystitis is comparatively rare in childhood and adolescence (DUKE ELDER), the present work shows that it is almost as common in childhood and adolescence as in the fifth decade, the commonest reported age for chronic dacryocystitis, the percentages being 28 per cent. and 26 per cent respectively.

The incidence of sex in group A is 3:4 male to female, in contrast to 21 males and 42 females above 15 years of age. Thus it is obvious that in acquired dacryocystitis there is hardly any predisposition to sex which is proved by lack of predilection of small pox and chicken pox to sex. The slight variation is further explained on the basis that more girls have acquired exanthematous diseases than boys in the series [Table - 2].

Most authors have shown that females outnumber males in the ratio of 4:1. Percentage of females in various series are TRAQUAIR 83 per cent, SUMMERSKILL 70 per cent, DUKE ELDER 75-80 per cent, PANDEY 82 per cent, SHRIVASTAVA 80 per cent, MATHUR, CHAKKO, EBENEZER and GOWRI KUMAR 69 per cent. Our observation of its presence at 67 per cent in female patients is comparatively lower than the above observations and is nearer the observations of SHUKLA 58 per cent and SOOD, RATANRAJ, BALARAMAN and MADHAVAN, 62 per cent.

The most striking observation hitherto not pointed out is the prevalence of acquired dacryocystitis to the extent of 82 per cent in children. Small pox and chicken pox were correlated to epiphora by the patients or relatives voluntarily or when questioned to that effect. Thus chicken pox (50 per cent) was the largest single factor while small pox (32 per cent) followed closeby.

Probable Role of Exanthemata

In majority of cases of acquired dacryocystitis the etiology is not clearIv understood. The factors that influence are age, sex, hereditary and familial tendency. While these are true for chronic dacryocystitis in adults, they do not seem to have much significance in the present study where more cases are from the age group 0-15 years, which otherwise is thought to be relatively free from this suffering.

Infection of lacrimal sac arises secondarily from nose, sinuses, conjunctiva, pericystic tissue and trauma. But these factors individually do not produce chronic infection, there may be other contributory factors e.g. anatomical predisposition in adult females.

Stasis of the contents is the most important prerequisite. The normal mucosa of the sac ordinarily is resistant to inflammation. There are a number of folds present in the mucosa lining the sac and nasolacrimal passage. On slight irritation these folds swell up sufficiently to cause accumulation of fluid on the proximal side. The submucosa which is rich in vascular and lymphatic supply gets readily congested, forming a suitable nidus for infection. With statis of the contents of the sac there is fall in resistance of the mucous membrane. A vicious circle of congestion-stasis-infection goes on till resistance to infection crumbles.

In the wide involvement of the skin and mucous membranes all over the body in small pox and chicken pox the conjunctiva, the nasopharynx and the lacrimal passage are not spared. Secondary infection and subsequent scarring of the mucous membrane of the lacrimal passages result when the vesicles heal. The stage is set for a full-blooded chronic dacryocystitis following the obstruction.


  Treatment Top


Treatment of chronic dacryocystitis in children is a problem in itself. However it can be divided into medical and surgical.

Medical Treatment

Medical treatment of chronic dacryocystitis in childhood is as futile as in adults. Once a full blown picture has set in, any amount of decongestants and antibiotics locally with or without systemic antibiotics is of no use. It is successful only in keeping the infection under control and preventing complications. Prophylactic instillation of antibiotic drops preferably an oily suspension of broad spectrum antibiotic in the conjunctival sac along with instillation of local decongestant in the conjunctival sac and nose prevents stasis and infection in the sac.

Surgical Treatment:

Surgery over the lacrimal sac is the treatment of choice for chronic dacryocystitis in children to make them rid of epiphora and pus discharge and prevent complications like corneal ulcer and hypopyon.

The widely used operation of removal of the sac in children should be preserved for only such cases where the safety of the eye is threatened by corneal ulcer or hypopyon or where other anastomosing operations have failed. The treatment of choice is establishment of the drainage in the nose either by dacryocysto rhinotomy or by intubation of the nasolacrimal duct with a polythene tube of suitable length which is properly anchored to prevent its dislocation into the nose.

The authors have tried the latter method in 25 children of chronic dacryocystitis. With one year follow up the method was found to be successful in 100 per cent cases.


  Summary Top


In 100 cases of chronic dacryocystitis including congenital dacryocystitis, the involvement of sex in different age groups has been noted. Involvement of more males in the present series than others has been pointed out. Exanthematous conditions as major etiology for chronic dacryocystitis in children has been stressed, and the probable role of exanthemata in producing chronic dacryocystitis has been discussed. Role of surgery especially intubation of the nasolacrimal duct with excellent results has been stressed.



 
 
    Tables

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